How to Treat Asymptomatic and Symptomatic Urinary Tract Infections in the Kidney Transplant Recipients?

Zafar Iqbal,Juan Fernando Ortiz,Nusrat Jahan,Amr Salem,Sawleha Arshi Khan

doi:10.7759/cureus.9608

Abstract

Patients with end-stage renal functions are treated with renal transplantation. After the transplantation, kidney transplant recipients (KTR) are at the risk of urinary tract infection (UTI). UTI in KTR may be symptomatic and asymptomatic. Asymptomatic UTI is the presence of the organisms without any signs and symptoms. There are various ways suggested in the published research papers to deal with UTI in the KTR. The goal of this literature review is to explore how to treat symptomatic and asymptomatic UTI in KTR. A PubMed search was conducted to identify the studies explaining the methods used to deal with UTI in KTR. A total number of 2158 articles were found while searching for regular keywords; however, we found 996 articles with the medical subject heading (Mesh) keywords. After applying the inclusion/ exclusion criteria, 56 articles with the regular keywords search and 29 articles with the Mesh keywords search were selected. These articles included 24 randomized clinical trials, 16 clinical trials, 7 review articles, 5 case reports, 2 controlled clinical trials, 2 observational studies, and 1 cross-sectional study. Our analysis has shown that the early removal of the stent after the transplantation and the use of antibiotics are beneficial in reducing the incidence of symptomatic UTI in the KTR; whereas, treating asymptomatic UTI in KTR has not been proven helpful in reducing the incidence of developing symptomatic UTI later on.

Highlights

BackgroundThe mortality rates in kidney transplant recipients (KTR) are approximately 8.6% within the five years of the transplantation
A total number of 2158 articles were found while searching for regular keywords; we found 996 articles with the medical subject heading (Mesh) keywords
Our analysis has shown that the early removal of the stent after the transplantation and the use of antibiotics are beneficial in reducing the incidence of symptomatic urinary tract infection (UTI) in the KTR; whereas, treating asymptomatic UTI in KTR has not been proven helpful in reducing the incidence of developing symptomatic UTI later on

Summary

Introduction

BackgroundThe mortality rates in kidney transplant recipients (KTR) are approximately 8.6% within the five years of the transplantation. The incidence of urinary tract infection (UTI) in the renal transplant recipients accounts for 45-72% of all the infections. [2] In the KTR, 30% of all hospitalizations are secondary to UTI [2]. Whether to treat KTR suffering from asymptomatic UTI with the antimicrobials and the impacts of antimicrobials therapy or dealing with the urinary catheters in individuals with symptomatic UTI after the transplantation have been discussed in these articles [4,5]. The knowledge of dealing with the asymptomatic and the symptomatic UTI in the KTR is important in order to improve the health of these individuals, minimize the incidence of hospital admission, and reduce the financial burden on the health sector

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